Fosamax and Tooth Extraction

If you need to have a tooth extracted and have been taking any kind of osteoporosis drug like Fosamax, Actonel or Boniva, BEWARE.  Going to the dentist is a scary prospect for so many people, me included, that when you finally work up the courage to go, the last thing you want to hear is that the dentist won't touch you.

This is what I experienced recently. I've had periodontal disease for a long time and do take additional measures besides thorough brushing to ward off more potential problems. Nevertheless, I did have a molar get loose. I've also been taking osteoporosis medication for about four years.

I waited for months before consulting a dentist. The dentist I chose was not my regular dentist because I was in Florida for the winter. Of course, I had to fill out the forms about my family history etc. and the medications I take. When I handed the completed forms to the receptionist, she read over it and then consulted the dentist. This was a very small office so I could see and hear what was going on. Imagine my surprise when I heard the dentist say, "I won't touch her!"

I said with indignation, "What does he mean he won't touch me? It's a simple extraction." From their reaction, I fully expected the dentist and assistants to don gloves, gowns and face masks as though I had leprosy or some other highly contagious disease.

"You take Fosamax," the woman said.

"I know. So what?"

By this time, I had entered their inner sanctum (the space beyond the waiting room where the exam rooms are located) and was talking to the receptionist.

"When you're taking osteoporosis drugs and need an invasive procedure like extraction or implants, serious complications can arise," she said.

Complications? I don't recall reading about complications when I first began taking the drug. That doesn't mean they weren't there. I just don't remember it and since I always read the contraindications of all medications before I take them,  I think a warning about dental procedures would have resonated with me because of my periodontal disease. Since my appointment time was already scheduled, I asked for a consultation with the dentist. I needed to learn more about this situation.

He informed me that while osteoporosis drugs strengthen the bones and protect them from fractures, there is something in them that prevent extractions and implants from healing properly in some cases. He said I should go to an oral surgeon. He recommended an oral surgeon who was also an MD, saying that is who he would go to or take his family to. They set up the appointment for me for two weeks hence.

Once again, I had to bolster my courage for the appointed day. It was a seventy mile trip one way which gave me plenty of time to calm down, get nervous, calm down over and over. I kept thinking it will soon be over. WRONG!

This dentist/doctor explained that he wanted blood work done before he could do the extraction. He also explained that the osteoporosis drugs, while protecting the bones, have a component that retards bone metabolism or bone turnover. Therefore, he needed a CTX blood scan to see what my number was. He also told me that the drug can remain in the system for up to eleven years. However, it is possible to stop taking the drug and that will elevate the CTX number to a safer level for dental work.

CTX stands for serum C-terminal Telopeptide bone metabolism. Now you know why people just say CTX. It measures the level of bone turnover and the safest number is 150 or higher.

To this day, I still don't understand how a medication can protect bones on the one hand and stop bones from healing on the other hand. I've researched this and haven't found any logical explanation.

I have learned that long term use of the drug can lead to osteonecrosis. That means your bone dies. The death of a bone in the jaw leads to horrors unimaginable. You can research it if you have a morbid curiosity. Actually, I know more than I ever wanted to know about that subject and I'll explain no further.

Let me hasten to tell you that it's a very small number of people who experience this because of a dental procedure. The few cases that are seen usually occur when the drug is being administered by IV.

Back to my story. There are a limited number of labs that perform the CTX test and to have it done requires a 12 hour fast. Seventy miles back home, call for an appointment for blood work, fast, drive forty miles the next day to have the blood work done. Wait two weeks for the results.

During the two week wait for the results, I researched this stuff extensively. Now I was really petrified on the day of the extraction. The dentist/doctor told me my CTX level was 137 but he'd do it anyway. Yipee!

I had requested novacaine rather than a general anesthetic because I don't like the after effects of generals. I'm not wild about injections either, but that's what I wanted. He swabbed the site with a local anesthetic, injected the novacaine and left me alone with the dental assistant while I got numb.

Within a minute, my vision blurred and I was seeing double. That had never happened to me before and I've had extensive dental work done. I didn't want to panic but I told the assistant what I was experiencing and that I wanted to see the guy NOW. At this point I sure was glad that this guy was an MD too.

He was doing another surgical procedure and couldn't be disturbed. It seemed like an hour but I'm sure it was only a few minutes before he came back into my room and nochalantly explained that epinephrine (the local anesthetic) sometimes has that side effect and would soon wear off. I told the assistant to please remember that for future patients that may have the same reaction.

Months have gone by and there have been no problems. Thank heavens the empty space is way in the back because there's no way I'd consider a dental implant. SMILE